Case 2
With discussion
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CASE 2 (April 2006)

Clinical information

A 20-years-old man was referred because one month earlier he developed facial and legs oedema, general malaise and oliguria.

On examination, blood pressure was 160/100, heart rate 90 beats per minute, respiratory rate 16 breaths per minute. He was in no distress; he did not have fever. The general physical and neurologic examinations disclosed legs grade II oedema and no other abnormalities.

Laboratory tests
Uurinary analyses: density 1,015, proteins 1,000 mg/24h, eritrocites: 15 HPF.
Hb: 12 mg/dL, white cells: 10,000 per mm3, platelets: 201,000 per mm3, creatinine 3.8 mg/dL, BUN 50 mg/dL, creatinine clearance: 24.1 mL/min, serum complement levels: normal, ANAs negative, antistreptolysin O (ASO) negative, total cholesterol: 210 mg/dL, triglyceride: 100 mg/dL, HDL 50 mg/dL, LDL 103 mg/dL.

What is your clinical diagnosis?

What is the differential diagnosis?

A renal biopsy was undertaken. See the images.

Figure 1. (H&E, x400)

Figure 2. (H&E, x400)

Figure 3. (Methenamine silver stain, x400)

Figure 4. (Immunofluorescence using antiserum to IgG, X400)

Figure 5. (Immunofluorescence using antiserum to C3, X400)


Immunofluorescence for IgA, IgM, and C1q were negative.


What is your diagnosis?

See diagnosis and discussion